When should we place a Midline instead of a PICC line? Midlines are lines that are 20cm in length, the tip terminates in the upper arm and can remain in for about 10 days. The patients that benefit the most from Midlines are those that we call “difficult sticks”, they can have diagnosis of dehydration, COPD, CHF and short term IV abx needs. This line is placed by PICC trained nurses, but can be taught to all nurses. Care and maintenance is the same as a PICC line, but the big difference is the tip is not central and the patient is at less risk for CR-BSI’s (catheter related blood stream infections). When assessing the patient for the best line for their therapy and needs, we should also consider this line. It takes less time to insert, complications are less, and it prevents multiple needle sticks in the patient with difficult access.
Another Vascular Access Device we need to think about when assessing the vascular access needs of our patients. When we receive an order for a "PICC" line we need to review the medical records and review the physician orders. As Vascular Access experts, we need to look at all devices, ask questions, discuss our findings with the health care team. We need to know what medication is being ordered?, what is the duration of therapy? and where is the patient going to receive therapy? Inpatient, Outpatient, Home Health or home without Home Health. This will all come in to play when deciding the best device, but also the eduction that needs to occur. We need to educate the entire team on all devices. Power-Injectable Midlines are a great device to add to our list of choices (best practice) for our patients.